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Kardiologia Polska 2013; 71, 8: 880; DOI: 10.5603/KP.2013.0207 ISSN 0022–9032
STUDIUM PRZYPADKU / CLINICAL VIGNETTE
Real-time three-dimensional transoesophageal echocardiographic imaging of an aorto-left atrial fistula
Trójwymiarowe obrazowanie w czasie rzeczywistym metodą przezprzełykową przetoki między aortą a lewym przedsionkiem
Ahmet Çagri Aykan
1, Mehmet Özkan
2, Mustafa O. Gürsoy
21Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
2Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
A 21-year-old man with Marfan syndrome with aortic and mitral mechanical prosthetic valve presented with a type-3 aor- tic dissection. A successful endovascular aortic repair with graft stent was performed. On the fifth day of admission, he was uneventfully discharged. But ten days later, he represented with dyspnoea, high fever (39.2°C) and chills. He had a 4/6 diastolic murmur at aortic point in physical examination. He had leukocytosis (27,000 × 109/L) and increased C-reactive protein (75 mg/L) levels on laboratory analysis. Transthoracic echocardiography was performed due to the suspicion of infective endocarditis which demonstrated a paraaortic abscess. Two- and real-time three-dimensional transoesophageal echocardiography (3D TEE) confirmed the presence of an abscess and showed a paravalvular leak through an aorto-left atrial fistula (Fig. 1). Furthermore, real-time 3D TEE clearly depicted that there were two openings into the left atrium (Fig. 2). Antibiotherapy was administered to the patient and he underwent a successful operation after the infection was controlled.
This case highlights that real-time 3D TEE may be superior to conventional transoesophageal echocardiography in evalu- ating complications of aortic prosthesis.
Address for correspondence:
Dr. Ahmet Çağrı Aykan, Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Soğuksu Mah., Çamlık Cad., 61040 Trabzon, Turkey, tel: 90 505 868 9461, fax: 90 462 231 0483, e-mail: ahmetaykan@yahoo.com
Conflict of interest: none declared
Figure 1. A. Asterisk indicates an aortic para- valvular abscess located between the native aortic wall and prosthetic aorta;
B. Severe mitral para- valvular regurgitation through this abscess cavity was demonstrated by TEE
Figure 2. A. Arrows show the openings of aorto-left atrial fistulas into the left atrium; B. Arrows indica- te colour full volume 3D TEE imaging of the two aorto-left atrial fistulas and localisation and ex- tension of abscess cavity A
A
B
B ˇ
